Patent application title: Blind rivet for adapting biological tissue and device for setting the same, in particular through the instrument channel of an endoscope
Hubertus Feussner (Munich, DE)
Joachim Heinzl (Munich, DE)
Ulrich Hausmann (Garching, DE)
Robert Paspa (Kirchheim, DE)
IPC8 Class: AA61B1708FI
Class name: Surgery instruments surgical mesh, connector, clip, clamp or band
Publication date: 2009-02-26
Patent application number: 20090054913
A self-piercing blind rivet is provided for apposing biological tissue
together with a device for setting the same, especially through the
instrumental channel of a flexible endoscope. Without the help of further
instruments, it is possible to fix, approximate and appose tissue layers,
the contact force while connecting the tissue layers being adjustable.
The rivets are stored in the setting device, so that they can be applied
in order. The rivet and setting device enable the surgeon to combine
tissue discontinuities conveniently by means of an endoscope. The
surgical procedure is simplified further because the rivets can remain in
1. Self-piercing blind rivet for apposing biological tissue wherein a
plurality of tissue layers of any thickness can be connected positively
with an adjustable contacting force, said rivet comprising a carrier with
a distal clip that is fixed on this carrier, and a proximal holder, which
can be shifted axially in the distal direction on this carrier.
2. The blind rivet of claim 1, wherein the distal end of the carrier is shaped with a needle point, in order to penetrate the tissue layers.
3. The blind rivet of claim 1, wherein the distal clip comprises a cylindrical body and two or more arms, which protrude from the carrier.
4. The blind rivet of claim 3, wherein the proximal holder is constructed as a clip and comprises a cylindrical body, two or more distal arms and two or more proximal wings.
5. The blind rivet of claim 4, wherein the arms and and wings of the clips make contact by elastic deformation.
6. The blind rivet of claim 4, wherein the arms and and the wings of the clips make contact and are opened by the memory effect of shape-memory material.
7. The blind rivet of claim 1, further comprising an arresting castellation, which permits a relative axial movement of the proximal clip only in the distal direction, on the carrier.
8. The blind rivet of claim 7, further comprising a coupling element at the proximal end of the carrier, to which an actuating element can be hooked and unhooked, by means of which the rivet is detached after the setting.
9. Device for setting a blind rivet of claim 4, having means for holding a plurality of rivets.
10. The device for setting a blind rivet of claim 9, comprising a guiding tube that surrounds the rivets in the initial state; with the arms and the wings of the two clips retracted, so that the rivets can be shifted axially.
11. The device for setting a blind rivet of claim 10, wherein the guiding tube forms a stop for the tissue and prevents the device as a whole from slipping in an uncontrolled manner through the tissue and the proximal holder forms a stop for the tissue, which prevents the rivet from slipping through the tissue in an uncontrolled manner.
12. The device for setting a blind rivet of claim 10, wherein the guiding tube is sized to be inserted in the instrument channel of an endoscope.
13. The device for setting a blind rivet of claim 10, wherein the guiding tube is the instrument channel of an endoscope.
14. The device for setting a blind rivet of claim 8, wherein the rivet is closed with the actuating element by pulling at the coupling element, as result of which the proximal holder, which is supported with the two wings of the rivet at the guiding tube, is pushed over the arresting castellation.
15. The device for setting a blind rivet of claim 2, wherein the pointed region of the distal end is covered, so that it does not remain hanging in the guiding tube.
16. The device for setting a blind rivet of claim 1, wherein the arms of the distal clip are configured so that their contacting when the tissue is pierced, and their subsequent springing open, are a reversible process, by means of which layers of tissue can be threaded consecutively onto the rivet, even when these were not held in contact with one another previously.
17. The device for setting a blind rivet of claim 10, wherein a thrusting force for advancing the rivets in the guiding tube is transferred via the carriers of the rivets forming a row, one behind the other.
18. The blind rivet of claim 1, wherein taperings and solid joints are provided in the carrier, which, together with the elasticity of the material of the same, adjust the flexibility of the carrier, so that the freedom of movement of the guiding tube is not limited and the range of uses of the endoscope is not hindered.
19. The blind rivet of claim 1, wherein at least the carrier is made of a biocompatible, bioabsorbable, material so that the rivet will maintain a closing force until the tissue itself is capable of carrying a load.
20. The blind rivet of claim 19, wherein the distal end is bioabsorbable significantly more rapidly than the rest of the rivet in order to minimize traumatization of the tissue and any organs surrounding the tissue.
21. The blind rivet of claim 2, the distal end is sheddable in order to minimize traumatization of the tissue and any organs surrounding the tissue.
22. The blind rivet of claim 2, wherein the distal end is bent over in order to minimize traumatization of the tissue and any organs surrounding the tissue.
23. The blind rivet of claim 2, wherein the distal end is covered, in order to minimize traumatization of the tissue and any organs surrounding the tissue.
24. The blind rivet of claim 1, wherein the proximal holder is combined with another medical device.
25. The blind rivet of claim 1, further comprising a dolly which surrounds the biological tissue and forms a support for the blind rivet, when the blind rivet is to be introduced.
26. The blind rivet of claim 19, wherein the tip of the carrier is made of an absorbable magnesium alloy.
27. The blind rivet of claim 26, wherein the magnesium alloy is magnesium A291.
The invention relates to a self-piercing blind rivet for apposing
biological tissue and to a device for setting the same, especially
through the instrument channel of a flexible endoscope, in order to
connect layers of tissue with an adjustable contacting force.
STATE OF THE ART
Blind rivets are usually used to connect metal sheets, predominantly in aircraft construction. However, they can also be used for other materials, such as plastics, wood or leather. Their great advantage over other forms of rivets is that the parts to be joined have to be accessible only from one side, since there is no need for a bottom die to close the rivet. For most blind rivets, holes, which are one above the other for setting the rivet, must be drilled to start with. There are, however, also blind rivets, for example, in the EP 0 705 389 B1, which are self piercing in that they pierce the parts to be joined automatically during the setting process.
In surgery also, there are first indications of the use of blind rivets. Their applications are limited, however, mainly to fixing implants or tissue to bones, as described in U.S. Pat. No. 6,241,732 B1 or the WO 99/62418. A corneal rivet (U.S. Pat. No. 5,258,011), by means of which it is possible to close cuts in the cornea of the eye, is also worth mentioning. This rivet, however, mainly is not constructed as a blind rivet and must instead be serviced from both sides, which makes use in endoscopy difficult and requires an additional instrument.
Suturing techniques are mainly used in medicine for apposing tissue. For example, attempts have been made to develop suturing devices for minimally invasive surgery to close off tissue discontinuities when operating on the gastrointestinal tract. Since the needle can no longer be guided with the fingers here, this guidance must be taken over by grippers. However, since these grippers do not attain even approximately the freedom of movement and the movement possibilities of the hand, this suturing is very difficult, uncertain and time consuming. For this reason, different devices for automated suturing have been planned and, in some cases, put into practice. U.S. Pat. No. 6,071,289 is an example of this. However, even with such a device, the most serious disadvantage of the suturing technique, namely, the knotting of the suture, cannot be eliminated. For this purpose, either a knot is made outside of the body and pushed through the instrument channel or the suture is knotted laboriously with grippers. Accordingly, because of their complexity and the therefrom resulting overall size, it has not yet been possible to insert such devices into the instrument channels of flexible endoscopes.
Because of the disadvantages of suturing devices, clamps and clips were developed as alternatives. These consist essentially of two arms, which are connected to one another and with which the tissue can be held together, as disclosed in the German patents 299 23 545 U1 or 102 03 956 A1. Since the arms can be expanded only to a very limited extent for this purpose, it is necessary that the tissue parts, which are to be joined, be approximated with a further device before the application, so that use by means of an endoscope is prevented.
The connecting element of the US patent application 2003/0125755 is a combination of a clip and a suturing method. A clip, which is detached from a suture with pliers, hangs at the end of a needle with suture. In this way, the problem of the knot is overcome. Once again, however, it is necessary to use a further instrument, so that the instrument channel of an endoscope cannot be used by itself.
The WO 99/60931 application represents a further embodiment, which may be regarded as a blind rivet. The clip here consists of a carrier, a distal fixing element and a proximal fixing element. For the function, a connecting sleeve between the two fixing elements is also provided here. The sleeve determines the distance between the fixing elements. For this reason, the extent of the tissue approximation is fixed. It is therefore not possible to connect tissues of different or unknown thicknesses using one and the same clip. This represents a major limitation for the surgeon. Associated with this is the fact that the contacting force, with which the tissue is held together, is also not adjustable, so that the surgeon cannot gain any feeling for the quality of the connection. Moreover, the functional reliability of the clip is also a cause for concern, since a stop has not been provided for the proximal fixation element, so that it may happen that the complete clip can be pushed through the tissue and, as it were, fall out on the other side. It is also not possible here to load the clips into a magazine, that is, to set several clips consecutively with one instrument. For reloading, the whole instrument must be exchanged or, at the very least, removed from the endoscope.
It is an object of the invention to avoid the aforementioned disadvantages by means of a connecting element and a device for setting these elements. Moreover, it shall be possible to connect any number of tissue layers of any thickness with a contacting force, which can be set by the surgeon, and the device shall be suitable for use in the instrument channel of a conventional, flexible endoscope. These objectives are accomplished with the self-piercing, blind rivet formulated according to claim 1.
Preferred variations and embodiments are listed in the dependent claims.
The blind rivet accordingly has a carrier, at the distal end of which a fixed clip is disposed, the tip of the carrier being constructed as a needle, with which the tissue is pierced. After the tissue is pierced, the distal, fixed clip comes into contact with the tissue and prevents the possibility of retracting the rivet. A holding device, which is supported at the opposite side of the tissue and, with that, fixes the position of the rivet, is provided on the proximal side of the carrier. This proximal holding device usually is a clip, the structure of which is similar to that of the fixed, distal clip, if only the approximation of the tissue layers matters.
The holding device may, however, also be a different device, or combined with this; accordingly, it is also possible to construct this holding device as a medication dispenser, as a diagnosis device with telemetric transfer, etc.
The invention is described in greater detail in the following with reference to the attached drawings, which show several, non-limiting embodiments. In the drawings,
FIG. 1 shows the construction of the self-piercing blind rivet,
FIG. 2 shows a rivet in the retracted state,
FIG. 3 shows a first tissue flap threaded and fixed,
FIG. 4 shows the closing of the rivet,
FIG. 5 shows a rivet in the applied state,
FIG. 6 shows the recess with the actuating element,
FIG. 7 shows the snapping into place of the actuating element in the recess,
FIG. 8 shows the uncoupling of the actuating element from the recess,
FIG. 9 shows the ejection of the tip,
FIG. 10 shows the folding over of the tip and
FIG. 11 shows the concealing of the tip.
The rivet, as shown in its relaxed form in FIG. 1, consists essentially of three parts. A tubular carrier 1 is provided at the distal end with a tip 2, in the middle part with an arresting castellation 3 and, at the proximal end, with a coupling element 4. Two clips 5 and 6 are mounted on the carrier, the distal clip 5 being axially fixed and the proximal clip 6 being displaceable in the distal, axial direction and being held in the opposite direction by the arresting castellation. The distal clip consists of a basic, cylindrical body from which two arms 5a branch out. The proximal clip also consists of a basic, cylindrical body, from which two arms 6a, as well as two wings 6b spread out. Within the carrier, there is an actuating element 7 with a latch at the distal end, with which it can hook into the coupling element and pull the carrier in the proximal direction. This actuating element is guided by a guiding tube 8.
In the closed state, as shown in FIG. 2 with the guiding tube 8 cut open, the two clips 5 and 6 contact the carrier 1 due to elastic deformation, so that the rivets in the guiding tube can be shifted. The rivets are inserted one into the other in such a manner, that the proximal end of the leading rivet is seated in the tip of the rivet 9 that follows. Accordingly, the rivets can be advanced by pushing the carrier of the last rivet in the series. It is also possible to retract the rivets, since the actuating element 7 is hooked into the coupling element 4 of the first rivet. Due to the fact that the rivets are plugged one into the other and because there is clearance, a joint results, which, together with the elasticity of the carrier, maintains the mobility of the instrument channel of the endoscope. Due to the geometry of the tip and a covering for the tip, it is avoided that the latter damages the guiding tube, especially when this tube is curved.
If the rivet is pushed out of the guiding tube 8, the distal clip 5 opens up, as can be seen in FIG. 3, due to the elastic pre-tension or due to the memory effect of the shape-memory materials. Tissue layers 10 are pierced in sequence with the tip 2 and secured by the distal clip and the guiding tube. By these means, it is possible to approximate the tissue layers with the rivet device without additional instruments.
It is also possible to use a dolly, which is guided, for example, in the instrument channel of the endoscope and embraces the tissue layers that are to be approximated, for setting the rivet, so that, when pierced with the needle, the tissue cannot move out of the way. The needle with the blind rivet can be guided in the same instrument channel within the dolly; a further instrument channel may also be provided for this purpose.
Moreover, an endoscope 11, in the instrument channel of which there is the riveting device, is shown in FIG. 3. It is equipped with an optical system 12 and a flushing channel 13. Accordingly, the riveting device is in the visual range of the endoscope. The instrument channel of the endoscope can also assume the task of the guiding tube.
As can be seen in FIG. 4, the rivet is closed owing to the fact that the rivet is pushed out of the guiding tube 8 until the arms 6a and then the wings 6b open up. The proximal clip 6 is supported with the wings at the guiding tube, when the carrier 1 is pulled in the proximal direction. This takes place by pulling at the actuating element 7, which is hooked into the coupling element 4. In this way, the proximal clip is pushed over the arresting castellation 3. At the same time, the arms 5a and 6a contact the tissue 10 and spread out as the contacting pressure is continued, until they are at an angle of about 90° to the carrier. During this process, the contacting pressure on the tissue layers is increased continuously. As the tightening is continued, the elasticity of the tissue is utilized in order to increase the contacting force further.
As can be seen in FIG. 5, in order to detach the rivet from the device, the actuating element 7 is left loose and the guiding tube 8 is pulled slightly in the proximal direction. As a result, the rivet 9 that follows is detached from the one recently applied. With that, the coupling element 4 is released and the actuating element can be uncoupled. The rivet has now been applied completely. The actuating element is then pulled in the proximal direction, until it is coupled to coupling element of the next rivet. The rivets are pushed in the guiding tube in the distal direction, until the distal clip of the next rivet opens up, so that this rivet is ready to be applied.
The construction of the coupling element 4 at the proximal end of the carrier 1 is shown in FIG. 6. It consists of a recess 4a, a stop 4b and a groove 4c. The actuating element 7 passes through the coupling element. As can be seen in FIG. 7, there is a lock 7b at the distal end of the actuating element 7, which essentially is a pull rope 7a. This lock hooks into the stop of the coupling, when the actuating element is pulled. If the actuating element is left loose, as can be seen in FIG. 8, and tilted with respect to the carrier, the lock detaches from the stop, so that the rivet is detached from the actuating element and, accordingly, from the device as a whole.
The tip 2 of an applied rivet represents a danger for the surrounding tissue and can lead to mechanical irritation (bleeding, perforation) of the same. There are several possibilities for avoiding this. According to the first possibility, the tip is produced from a bioabsorbable material, which is broken down within a few days or hours by the body; this is the case, for example, with various magnesium alloys, such as AZ91. Plastics, such as different lactides, are also suitable for this purpose. However, magnesium alloys offer the advantage of a hardness, which is required for puncturing the tissue and passing through it.
According to FIG. 9, the tip can also be cast off. This can be realized in that the tip is pushed onto the carrier 1 and, during the closing of the rivet, the distal clip 5 pushes the tip down from the carrier. If the rivet is used in the gastrointestinal tract, the cast off tip is excreted. A further possibility, as in FIG. 10, consists therein that the tip is folded back and, with that, the danger of traumatizing is decreased. Hiding the tip, as shown in FIG. 11, represents the last possibility. The basic cylindrical body of the distal clip 5 is elongated with a sleeve, which is pushed over the tip while the rivet is being closed, hiding the tip and keeping it away from the adjacent tissue.
The materials used are of great importance. Biocompatible materials must be used for all components of the rivet, that is, for the carrier 1, the tip 2 and the two clips 5, 6, in order to avoid information. Moreover, it is desirable that the rivet can remain in the body and is broken down at the conclusion of the wound healing process. For this reason, the carrier 1 is produced from bio-absorbable poly-(D/L)-lactide, which is broken down after several months. The two clips are produced from an aliphatic polyether-based or polycarbonate-based TPU. As already mentioned, the AZ91 magnesium alloy should be used if the tip is to be absorbed very rapidly. The actuating element 7 is produced from spring steel, in order to be able to transfer tensile forces. A low-friction plastic, such as PTFE, is suitable for the guiding tube 8.
As already mentioned above, instead of the second clip, a different type of holder or a device may be provided, such as a medication dispenser, etc. In this case, the distal clip is used essentially for fixing the device in the tissue.
LIST OF REFERENCE NUMBERS
Carrier 1 Distal end of the 2 carrier Arresting 3 castellation Coupling element 4 Recess 4a Stop 4b Nut 4c Distal clip 5 Arm of the distal 5a clip Clip Proximal clip 6 Arm of the proximal 6a clip Clip Wing of the proximal 6b clip Clip Actuating element 7 Guiding tube 8 Subsequent rivet 9 Tissue 10 Endoscope 11 Optical system 12 Flushing channel 13
Patent applications in class Surgical mesh, connector, clip, clamp or band
Patent applications in all subclasses Surgical mesh, connector, clip, clamp or band